PNPLA3 and metabolic dysfunction-associated steatohepatitis: Indeed, 1) predisposition to NASH appears to cluster with that for metabolic risk factors within families, 2) ethnic differences, partially explained by a different prevalence of patatin-like phospholipase domain-contain 3 protein (PNPLA3) variants, have been reported [10-12], and 3) studies in twins demonstrated a high heritability of liver enzymes values reflecting liver fat content [13].